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Individual

CHRISTINE M SUSURAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.-C.

Contact information

Practice address
5779 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
5779 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2743
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
86080015085259C464
TRIWEST
AZ
05
939796
AZ
01
P00625190
RAILROAD MEDICARE
AZ
Enumeration date
12/07/2005
Last updated
10/29/2008
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